ePoster #1210 - ISHA Annual Scientific Meeting 2016

Severity Of Chondral Damage Increases With Age, But Does Not Affect Short-Term Outcomes For Hip Arthroscopy Patients

Maureen Dwyer, PhD, ATC, Newton, MA UNITED STATES
Jo Ann Lee, NP, Newton, MA UNITED STATES
Joseph C. McCarthy, MD, NEWTON, MA UNITED STATES

Newton Wellesley Hospital, Newton, MA, UNITED STATES

FDA Status Not Applicable

Summary: Our findings suggest that outcomes following hip arthroscopy can be affected by a multitude of factors, and patient age alone should not deter from arthroscopic treatment, particularly if mechanical symptoms are present.

Abstract:
Introduction Age has been identified as a potential detractor to performing hip arthroscopy, as older patients may experience inferior outcomes. We examined the degree of chondral damage present in the hip at time of arthroscopy at different decades of age and determined the effect of multiple patient factors, including age, on short-term outcomes following arthroscopy. Methods Between 2012-2014, we identified 149 patients (99 females, 50 males; age: 36.5±11.9 years) who underwent hip arthroscopy by the senior author. The articular cartilage of the posterior, superior, and anterior regions of the acetabulum and femoral head were assessed for signs of chondral damage during surgery. The degree of damage was classified as normal, mild (grades I/II), or severe (grades III/IV). Patients completed the modified version of the Harris Hip Score (MHHS) at their 12-week post-surgical appointment (3M). Three months was chosen as this is the timeframe that many patients are allowed back to full activity. Patients were divided into four groups based on their decade of age (<30 years (n=49), 30-39 years (n=38), 40-49 years (n=40), >50 years (n=22)). The degree of damage for each region was compared between each age group using Chi-Square analyses. Scores on the MHHS were compared between each age group for using one-way analysis of variance (ANOVA). Good-excellent outcome (GEO) was defined as scores = 80 points on the MHHS. All patients were grouped based on whether they achieved GEO, and patient factors that may contribute to GEO were assessed using Chi-Square analyses: age group, sex, dysplasia, revision, history of low back pain (LBP), and presence of severe damage at surgery. Results The degree of articular cartilage damage increased incrementally for each decade of age. The increase in chondral damage reached significance for the posterior (p=0.031), superior (p=0.003), and anterior (p=0.029) regions of the femoral head and the posterior (p=0.041) and superior (p=0.001) regions of the acetabulum. The percentage of patients with chondral damage in the anterior acetabulum did not differ between age groups (p=0.25). MHHS scores at 3M did not differ between age groups (<30y: 82.9±13.0; 30-39y: 78.7±12.9; 40-49y: 80.9±13.3; >50y: 78.0±12.2; p=0.35). Overall, 56% (n=85) of patients achieved GEO at 3M. The percentage of GEO did not differ between age groups (<30y: 65%; 30-39y: 45%; 40-49y: 60%; >50y: 55%; p=0.27). Only female sex (p=0.04) and history of low back pain (p=0.005) resulted in reduced prevalence of GEO. Discussion and Conclusions Our findings demonstrate that, while the degree of chondral damage increased during each decade of age, age did not result in inferior outcomes at 3 months post-arthroscopy. The only factors that independently resulted in reduced outcomes were female sex and history of low back pain. Although we only assessed short-term outcomes, our findings suggest that outcomes following hip arthroscopy can be affected by a multitude of factors, and patient age alone should not deter from arthroscopic treatment, particularly if mechanical symptoms are present.